Perineural spread of cutaneous head and neck cancer. Its orbital and central neurologic complications.
The ability of cutaneous squamous cell carcinoma of the face to cause ophthalmoplegia or central nervous system dysfunction via perineural spread is not well recognized. Five patients presenting to a general neurology unit are described in whom partial or complete ophthalmoplegia developed following fifth and seventh cranial nerve involvement by cutaneous squamous cell carcinoma. Two patients subsequently developed a contralateral hemiparesis; and one, multiple cranial nerve palsies as the tumor spread centrally. Normal radiologic findings or complete healing of the primary skin lesion caused delay in the diagnosis in three of the patients. When ophthalmoplegia or central nervous system dysfunction develops as a consequence of perineural spread of cutaneous facial cancer, management is palliative.
Clouston
P D
PD
Department of Neurology, Repatriation General Hospital, Concord, Sydney, Australia.
Sharpe
D M
DM
Corbett
A J
AJ
Kos
S
S
Kennedy
P J
PJ
D000368:Aged; D001921:Brain / Q000000981:diagnostic imaging; D002294:Carcinoma, Squamous Cell / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology*; D003390:Cranial Nerve Neoplasms / Q000150:complications / Q000175:diagnosis / Q000473:pathology / Q000556:secondary*; D005155:Facial Nerve Diseases / Q000150:complications / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology; D005158:Facial Paralysis / Q000175:diagnosis / Q000209:etiology / Q000473:pathology; D006258:Head and Neck Neoplasms / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology*; D006801:Humans; D008297:Male; D009460:Neurologic Examination; D009886:Ophthalmoplegia / Q000175:diagnosis / Q000209:etiology / Q000473:pathology; D009918:Orbital Neoplasms / Q000150:complications / Q000175:diagnosis / Q000473:pathology / Q000556:secondary*; D012878:Skin Neoplasms / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology*; D012886:Skull / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed; D014276:Trigeminal Nerve